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Lesbian and bisexual mothers and nonmothers: demographics and the coming-out process.

In a large, national sample of 2,431 lesbians and bisexual women, those who had children before coming out, those who had children after coming out, and those who did not have children were compared on demographic factors and milestones in the coming-out process. Differences were found in race/ethnicity, age, prior marriage, income, religion, use of mental health counseling, and reported hate crimes. Results are also presented for lesbians and bisexual women of each ethnic/racial and age group. Controlling for age and income, lesbians and bisexual women who had children before coming out had reached developmental milestones in the coming-out process about 7-12 years later than women who had children after coming out and about 6-8 years later than nonmothers.

Adult↗

Gay and bisexual men's age-discrepant childhood sexual experiences.

This study examined childhood sexual abuse (CSA) in gay and bisexual men. We compared the conventional definition of CSA based on age difference with a modified definition of CSA based on perception to evaluate which definition best accounted for problems in adjustment. The sample consisted of 192 gay and bisexual men recruited from a randomly selected community sample. Men's descriptions of their CSA experiences were coded from taped interviews. Fifty men (26%) reported sexual experiences before age 17 with someone at least 5 years older, constituting CSA according to the age-based definition. Of these men, 24 (49%) perceived their sexual experiences as negative, coercive, and/or abusive and thus were categorized as perception-based CSA. Participants with perception-based CSA experiences reported higher levels of maladjustment than non-CSA participants. Participants with age-based CSA experiences who perceived their sexual experience as non-negative, noncoercive, and nonabusive were similar to non-CSA participants in their levels of adjustment. These findings suggest that a perception-based CSA definition more accurately represents harmful CSA experiences in gay and bisexual men than the conventional age-based definition.

Adult↗

AIDS and chemical dependency: special issues and treatment barriers for gay and bisexual men.

Because gay and bisexual men continue to be the largest at-risk group for human immunodeficiency virus (HIV) related conditions, the special role of substance abuse, and not just intravenous drug abuse, must be understood in order to provide adequate services and prevention. Gay men and women appear to have a higher incidence of substance abuse than the general population. Genetic, biochemical, societal, and cultural factors may all contribute to this increase, especially the overwhelming impact of societal homophobia. To address the treatment barriers to gay and bisexual men seeking or needing treatment for HIV-related conditions, chemical dependence or both, the gay community should be seen like any other minority community. The social and cultural norms of this widely varied community should be studied: the socialization of being gay in mainstream society, including the awareness of being different; the coming-out process; and dealing with internalized homophobia need to be understood. In addition, the resistance or anxiety health care providers may feel in working with gay or bisexual men or with HIV-related conditions should be addressed.

Acquired Immunodeficiency Syndrome↗

The sexual behaviour of bisexual men in relation to HIV transmission.

Relatively little is known about the behaviour of bisexual men which may help in assessing their role in HIV transmission. A sample of 60 behaviourally bisexual men were asked about their sexual behaviour with male and female partners and their perceptions of risk of HIV infection. Only a minority of men engaged in unprotected anal sex with their male partners while two thirds had unprotected vaginal sex with their female partners. This asymmetrical pattern of sexual behaviour reflects a differential perception of risk of HIV infection with male and female partners. A quarter of the men had unprotected penetrative sex with both male and female partners in the previous year. The pattern of risk behaviour varied amongst men living in gay, heterosexual or bisexual contexts.

Adult↗

Preventing HIV among Latino and African American gay and bisexual men in a context of HIV-related stigma, discrimination, and homophobia: perspectives of providers.

HIV-related stigma, discrimination, and homophobia impede community-based efforts to combat HIV disease among Latino and African American gay and bisexual men. This commentary highlights ways to address these social biases in communities of color in Los Angeles, California, from the perspectives of staff from HIV prevention programs. Information was collected from HIV prevention program staff participating in a 2-day symposium. The outcomes from the symposium offer strategies for developing and implementing HIV prevention services for Latino and African American gay and bisexual men, which include: (1) addressing social biases present in a community that can hinder, and even prohibit, utilization of effective HIV prevention programs; (2) recasting HIV prevention messages in a broader social or health context; (3) developing culturally appropriate HIV prevention messages; (4) exploring new modalities and venues for delivering HIV prevention messages that are appropriate for gay and bisexual men of color and the communities in which they live; and (5) broadening the target of HIV prevention services to include service providers, local institutions and agencies, and the community at-large. These strategies underscore the need to consider the social and contextual factors of a community when designing and implementing HIV prevention programs.

Black or African American↗

Drug use, drug severity, and help-seeking behaviors of lesbian and bisexual women.

BACKGROUND: Illicit substance use and abuse may be an important contributor to behavioral health problems of lesbian and bisexual women. This paper describes the nature and extent of self-reported illicit and licit drug use, associated severity, and substance use-related helpseeking behaviors in an urban/metropolitan community sample of sexual minority women in California. METHODS: Self-administered questionnaire data from 2011 lesbian and bisexual women recruited through multiple strategies were used. Multiple logistic regression was employed to describe patterns of reported drug use and to compare lifetime severity of drug use with demographic characteristics, recent drug use, indicators of current social and emotional problems, and help-seeking behaviors. RESULTS: Drug use, especially marijuana (33% used in the past year), was fairly common. Overall, 16.2% of the women in the study reported lifetime drug use that was associated with self-reported severity of substance use, and another 10.8% indicated moderate-risk use. Extent of lifetime drug use was positively correlated with self-reported recent drug use as well as current life problems. Of the respondents who evidenced more problematic drug use, 41.5% indicated that they had received professional help for a substance use problem, and 16.3% wanted but had not received such help. CONCLUSIONS: The women in this study reported elevated rates of illicit drug use that was frequently associated with impairment and specific life problems. A significant proportion wanted and had not received professional treatment for their drug use problems. Future studies that examine pathways by which lesbians and bisexual women can obtain referrals and treatment for substance use problems are needed.

Adult↗

Sex trade involvement and rates of human immunodeficiency virus positivity among young gay and bisexual men.

BACKGROUND: Susceptibility to human immunodeficiency virus (HIV) infection is of particular concern for marginalized populations. The objective of this study was to determine risk factors associated with sex trade work among young gay and bisexual men. Further, we aimed to compare HIV prevalence and incidence among men involved and not involved in sex trade work. METHODS: The study is based upon data obtained from a prospective cohort study of young gay and bisexual men. Participants had completed a baseline questionnaire which elicited information on demographic information, sexual behaviours, and substance use. Sex trade involvement was defined as the exchange of money, drugs, goods, clothing, shelter or protection for sex within the one year prior to enrollment. Contingency table and multivariate logistic regression analyses were used to identify risk factors associated with involvement in the sex trade. RESULTS: Of the 761 eligible participants, 126 (16%) reported involvement in sex trade work. Multivariate logistic regression analysis revealed regular alcohol use (Odds Ratio [OR] = 3.6, 95% CI : 1.8-7.2), aboriginal ethnicity (OR = 3.7, 95% CI : 1.6-8.7), unemployment (OR = 3.9, 95% CI : 2.1-7.3), history of residence in a psychiatric ward (OR = 4.2, 95% CI : 1.8-9.8), bisexual activity (OR = 7.0, 95% CI : 3.5-14.1) and the use of crack (OR = 7.4, 95% CI : 3.0-18.7) to be independently associated with sex trade work. Sex trade workers had a significantly higher HIV prevalence at baseline compared with non-sex trade workers (7.3% versus 1.1%, P < 0.001). As well, HIV incidence was found to be significantly higher for sex trade workers compared with non-sex trade workers (4.7% versus 0.9%, P = 0.011). CONCLUSION: Our study reveals that for male sex trade workers in this setting increased vulnerability to HIV infection is related to unfavourable living conditions, substance use and sexual risk behaviour.

Adult↗

Detection of the hepatitis G virus genome among injecting drug users, homosexual and bisexual men, and blood donors.

The recently identified hepatitis G virus (HGV) is parenterally transmitted; the impact of sexual transmission is unknown. Moreover, it is unclear what proportion of HGV-infected persons may develop persistent viremia. Sera from injecting drug users (IDUs), non-drug-injecting homosexual and bisexual men with high levels of sexual risk behavior, and blood donors were tested for HGV RNA and hepatitis C virus (HCV) RNA by reverse transcriptase-polymerase chain reaction and for antibodies to human immunodeficiency virus, hepatitis B virus, and HCV. HGV RNA was detected in 33% of IDUs (n = 130), 11% of homosexual and bisexual men (n = 101), and 2% of blood donors (n = 90). HGV RNA seroprevalence significantly decreased with increasing time since first drug injection, whereas the seroprevalences of both HCV RNA and anti-HCV antibody increased. Thus, a high proportion of HGV-infected persons may clear the virus and develop protective antibodies. The relatively high HGV RNA prevalence among non-drug-injecting homosexual and bisexual men indicates that sexual contact may be another important route of HGV transmission.

Adult↗

Seroprevalence of human immunodeficiency virus type 1 and sexual behaviors in bisexual African-American and Hispanic men visiting a sexually transmitted disease clinic in New York City.

A cross-sectional human immunodeficiency virus type 1 (HIV-1) serosurvey was conducted between January 1988 and January 1993 at a New York City sexually transmitted disease clinic serving predominantly African-American and Hispanic patients. Overall, 14% (415/3,069) of participating men reported having sex with men; among these, only 52 (13%) were classified as "homosexual" (having had sex with men exclusively since 1978). Most men (87%) who reported having sex with other men also reported having sex with women. These included 147 (35%) "bisexuals" (sex with more than one man and at least one woman since 1978) and 216 (52%) "heterosexuals" (sex with women since 1978 and sexual contact with men before 1978 or only once thereafter). Although HIV-1 seroprevalence was highest among "homosexual" men (70%, 95% confidence interval (CI) 55-81), it was also high among "bisexual" men (35%, 95% CI 27-43) and "heterosexual" men (17%, 95% CI 13-23), and was lowest in men who reported having no male sex partners in their lifetime (9%, 95% CI 7-10). It is possible that transmission of HIV-1 from bisexual men to female sexual partners plays a greater role in heterosexual transmission than was previously recognized.

Adolescent↗

Time from HIV seroconversion to oral candidiasis or hairy leukoplakia among homosexual and bisexual men enrolled in three prospective cohorts.

OBJECTIVES: We evaluated time from HIV seroconversion to diagnosis of two common oral lesions associated with HIV infection and disease progression. DESIGN: Oral examinations were performed on homosexual and bisexual men enrolled in prospective cohorts. SETTING: Homosexual and bisexual men were followed in three epidemiologic cohort studies in San Francisco, California, USA. PARTICIPANTS: Data were evaluated from 80 men with well-defined dates of HIV seroconversion from 1984 through 1991. MAIN OUTCOME MEASURES: We determined the cumulative incidence of oral candidiasis and hairy leukoplakia after HIV seroconversion. RESULTS: Four per cent of men developed oral candidiasis within 1 year after HIV seroconversion, 8% within 2, 15% within 3, 18% within 4, and 26% within 5 years. Nine per cent developed hairy leukoplakia within 1 year, 16% within 2, 25% within 3, 35% within 4, and 42% within 5 years. The median CD4+ count was 391 x 10(6)/l when oral candidiasis was first reported and 468 x 10(6)/l when hairy leukoplakia was first reported. CONCLUSIONS: Oral candidiasis or hairy leukoplakia appeared in a significant proportion of HIV-infected homosexual and bisexual men. These lesions occurred relatively soon after HIV seroconversion, typically before AIDS. Evaluation of HIV-infected individuals for these lesions has many potential clinical and research benefits, including the possible use of oral lesions as primary end-points in clinical trials.

AIDS-Related Opportunistic Infections↗

Do bisexual men play a significant role in the heterosexual spread of HIV?

BACKGROUND AND OBJECTIVES: To assess the potential role of bisexual men in the transmission of HIV to women. STUDY DESIGN: The study population consisted of homosexual men participating in a longitudinal cohort study on HIV and AIDS in Amsterdam, the Netherlands, which started in 1984. Between April and November 1991, an additional questionnaire was administered concerning sexual behavior with both male and female partners in the last 6 months. RESULTS: Of these men, 27% described their sexual preference as bisexual or heterosexual. In the last 6 months, 23 (3%) had heterosexual contacts. Vaginal intercourse was the sexual technique most practiced. Anal intercourse with a female partner was rare. Four heterosexual active HIV positive men always used condoms when having heterosexual contact (1 missing). Of the 18 heterosexually active HIV seronegative men, 12 did not use condoms consistently with their female partner(s). Two of these 12 men also had unprotected insertive anogenital intercourse with male partners, which conveys a small transmission risk in the window period in the case of a seroconversion. CONCLUSION: Widespread transmission of HIV from these homosexual men in this study is not likely. However, the studied men are most probably not representative for homosexual men in Amsterdam, the Netherlands. Further study on the potential role that bisexual men play in the HIV transmission to women is therefore needed.

Acquired Immunodeficiency Syndrome↗

Longitudinal patterns of sexual behavior and condom use in a cohort of HIV-negative gay and bisexual men in Vancouver, British Columbia, Canada, 1995-2000.

OBJECTIVE: To characterize longitudinal patterns of sexual behavior in a cohort of young gay and bisexual men and determine their reasons for not using condoms. METHODS: Prospective data from a cohort of young gay and bisexual men aged 18 to 30 years were studied. Study participants had completed a baseline questionnaire and HIV test between May 1995 and April 1996 and four annual follow-up questionnaires. RESULTS: A total of 130 HIV-negative Vanguard participants met the eligibility criteria for this analysis. The median age at baseline was 26 years (range, 24-28). Most were white (79%), had completed high school (85%), were currently employed (82%), lived in stable housing (95%), and reported annual incomes of > or =$10,000 (82%). (All dollar amounts are given in Canadian dollars.) Consistently over the 5-year study period, > 70% of study subjects reported having > or =1 regular male sexual partners in the previous year. During each of the five successive 1-year periods, between 34% and 40% of respondents reported having had unprotected receptive anal intercourse with regular partners. Slightly fewer individuals (between 29%-39%) reported having had unprotected insertive anal intercourse with regular partners. Between 13% and 25% of participants reported having had insertive unprotected anal intercourse with casual sexual partners; and between 9% and 18% reported having had unprotected receptive anal intercourse with casual sexual partners. Reasons for engaging in unprotected anal intercourse varied depending on type of sexual partnership. CONCLUSION: High-risk sexual behaviors remained fairly consistent over a 5-year period in this study. This suggests that it is critically important to understand the motivations for unprotected sex when designing and implementing programs aimed at reducing HIV risk among young gay and bisexual men.

Adolescent↗

Sexual harm reduction practices of HIV-seropositive gay and bisexual men: serosorting, strategic positioning, and withdrawal before ejaculation.

OBJECTIVE: This study assessed unprotected anal and oral sex behaviors of HIV-positive gay and bisexual men in New York City and San Francisco with their main and non-main sexual partners. Here we focus on the use of three harm reduction strategies (serosorting, strategic positioning, and withdrawal before ejaculation) in order to decrease transmission risk. METHOD: The data from a baseline assessment of 1168 HIV-positive gay and bisexual men in the two cities were utilized. Men were recruited from a variety of community-based venues, through advertising and other techniques. RESULTS: City differences were identified, with more men in San Francisco reporting sexual risk behaviors across all partner types compared with men in New York City. Serosorting was identified, with men reporting significantly more oral and anal sex acts with other HIV-positive partners than with HIV-negative partners. However, men also reported more unprotected sex with partners of unknown status compared with their other partners. Some evidence of strategic positioning was identified, although differences were noted across cities and across different types of partners. Men in both cities reported more acts of oral sex without ejaculation than with ejaculation, but the use of withdrawal as a harm reduction strategy for anal sex was more common among men from San Francisco. CONCLUSION: Overall, evidence for harm reduction was identified; however, significant differences across the two cities were found. The complicated nature of the sexual practices of gay and bisexual men are discussed, and the findings have important implications for prevention efforts and future research studies.

Adult↗

Barebacking identity among HIV-positive gay and bisexual men: demographic, psychological, and behavioral correlates.

OBJECTIVES: To determine the correlates associated with barebacking identity among HIV-positive gay and bisexual men. DESIGN: An analysis of data from the baseline quantitative assessment of a randomized controlled intervention study of 1168 HIV-positive gay and bisexual men from New York City and San Francisco. METHODS: Participants were actively and passively recruited from mainstream gay venues, AIDS service organizations, and public and commercial sex environments. Participants completed a computerized quantitative questionnaire assessing their identity as a barebacker, sexual behavior, demographic factors, psychosocial states, perceptions of health risks, and substance use. RESULTS: Men of color were less likely to identify themselves as barebackers. Men who did identify themselves as barebackers were slightly younger. They were more likely to miss a dose of medication; report drug use (non-injection and injection); exhibit higher levels of sexual compulsivity and lower personal responsibility for safer sex; and report higher rates of unprotected insertive anal intercourse, unprotected receptive anal intercourse, and unprotected insertive oral intercourse with all partners, regardless of their HIV serostatus. CONCLUSION: Barebacking and its corresponding behaviors pose immediate public health risks for HIV-positive gay and bisexual men. Further work is needed to understand this phenomenon more fully in relation to the psychological, sociological, biomedical, and cultural realities.

Adolescent↗

Consistent, inconsistent, and non-disclosure to casual sexual partners among HIV-seropositive gay and bisexual men.

OBJECTIVE: This study examined the disclosure of HIV status to casual sex partners, factors related to disclosure, and the relationship between disclosure and HIV sexual risk behaviors among a sample of HIV-positive gay and bisexual men in New York City and San Francisco. Comparisons were made particularly among men who reported consistent disclosure, inconsistent disclosure, and non-disclosure. METHOD: The data from a baseline assessment of 1168 HIV-positive gay and bisexual men in the two cities were utilized. Men were recruited from a variety of community-based venues, through advertising, and other techniques. RESULTS: Consistent disclosers reported greater self-efficacy for disclosing and more intentions to disclose than other men. They also reported less drug use, lower incomes, and more perceived viral consequences resulting from unsafe sex than did inconsistent disclosers. Overall, sexual risk behaviors were greater among inconsistent disclosers, followed by non-disclosers, with consistent disclosers reporting the fewest HIV sexual risk behaviors. CONCLUSION: Disclosure is not an all-or-nothing process, as evidenced by the 38% of men in the sample who reported disclosing to some, but not all, of their casual sexual partners. These inconsistent disclosers, who reported the most sexual risk practices, seem to lack strategies to deal with disclosure and risky sex. Some men who never disclose appear to have been able to adopt strategies by which they do not engage in sexual risk with casual partners. Interventions to improve self-efficacy for disclosure and help HIV-positive gay and bisexual men to identify and adopt specific strategies to address disclosure and safe sex are needed.

Adult↗

A longitudinal study of the association between treatment optimism and sexual risk behavior in young adult gay and bisexual men.

To determine whether optimism about highly active antiretroviral therapy is associated with sexual risk behavior among young adult HIV-negative gay and bisexual men, and to test 2 alternative explanations for this association: that treatment optimism leads to increased sexual risk or that treatment optimism is the result of previous sexual risk. Data on sexual risk behavior, treatment optimism, and perceived susceptibility to HIV infection were obtained from a sample of 538 HIV-negative or untested gay and bisexual men (ages 18-30) who were not in monogamous relationships. Follow-up data were collected 18 months later. In the cross-sectional data, treatment optimism was associated with the 2-month cumulative incidence of unprotected anal intercourse (UAI) with nonprimary partners; however, this effect was observed only among men who felt highly susceptible to HIV infection. Longitudinal analyses revealed that treatment optimism did not predict subsequent UAI, but UAI did predict later treatment optimism. Treatment optimism is associated with sexual risk behavior among young adult gay and bisexual men. However, these data suggest that optimism may result from, rather than precede, sexual risk.

Adolescent↗

Sexual health risks and protective resources in gay, lesbian, bisexual, and heterosexual homeless youth.

ISSUES AND PURPOSE: To compare sexual health risks and protective resources of homeless adolescents self-identified as gay (G), lesbian (L), or bisexual (B), with those self-identified as heterosexual, and to determine the differences between these two groups and the differences within the GLB group. DESIGN AND METHODS: A secondary analysis of survey data collected from a nonprobability sample of 425 homeless adolescents between 16 and 20 years of age. RESULTS: Sexual health risks and protective resources differed between those self-identified as GLB and those self-identified as heterosexual. More G/L youth reported a history of sexual abuse and being tested and treated for HIV, and more scored lower on the assertive communication measure than did bisexual or heterosexual youth. Moreover, there were gender differences within the GLB group; more males than females self-identified as homosexual and more females than males self-identified as bisexual. PRACTICE IMPLICATIONS: Sexual health interventions for this population should be both gender- and sexual orientation-specific.

Adolescent↗

Indicators of male bisexual activity in semimetropolitan New South Wales: implications for HIV prevention strategies.

Between July 1993 and March 1994, advertising in the personal columns of local print media was used as a subterfuge to obtain access to homosexually active men living on the Central Coast of New South Wales. The men were invited to make contact by phone and were then requested to answer 44 survey questions. The survey was based on a premise that there existed a subgroup of homosexually active men who did not identify themselves as gay and who were behaviourally bisexual (the study population). Out of 296 contacts, 106 completed questionnaires concerning demographics, aspects of sexual behaviour, and attitudes and knowledge about sexual practice and self-definition. The sampling did provide access to a predominantly behaviourally bisexual group of men who did not identify themselves as gay and for whom the use of 'beats' was the most common method for meeting other men. There existed a high degree of accurate knowledge and practice of safe sex. However, several areas of concern warrant continued and new strategies to minimise the risk of human immunodeficiency virus (HIV) transmission in the study population. While the results might not be generalisable to the entire population of behaviourally bisexual men who do not identify themselves as gay, they do (in the absence of other successful ways of reaching this group), provide a useful indicator for the development of such strategies.

Adult↗